The Evaluation of Lipid-Lowering Treatment in Patients with Acute Coronary Syndrome in a Hungarian Invasive Centre in 2015, 2017, and during the COVID-19 Pandemic—The Comparison of the Achieved LDL-Cholesterol Values Calculated with Friedewald and Martin–Hopkins Methods

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Interesting study reporting the lipid lowering strategy in ACS patients from single Hungarian center in different references year, including the COVID-19 pandemic period. Of note, authors have reported the data also according to the Martin-Hopkins methods.

Results are consistent with poor goal achievement in LDL lowering strategy. This observational data focus on the large proportion of intervention still required in post ACS patients.

Some points could be improved:

A more characterized metabolic profile of patients should be reported, such as the proportion of hypertension, diabetes mellitus, obesity, MAFLD, glycemia, in a table.

Have any patients received PCSK9 inhibitors at discharge? Has someone during the follow-up period? In general, do authors have data about up titration of lipid lowering strategy at 6 months?

Report in the first row of table 1 and table 3 the number of patients with informative data about cholesterol measurement, as well as please specify and eventually split the data according to the year of enrollment and consider testing if any differences in the goal achievement exists.

Crucial interplay between lipid lowering therapy, platelet and inflammation exists, enhancing the cardiovascular risk: integrate the discussion (ie: PMID 36893777; 30150123; 24049520 )

 

Minor consideration:

-       Did author have consideration about the incidence of statin-related myopathy and concomitant omega-3 supplements?

-       Please shorten the introduction.

-       Please report the figure 1 also according to the latest threshold of 1.40 mmol/L of LDL-C.

-       Please use the same font for figure and text.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors

Thank you for your paper on the important issue of lipid-lowering treatment after ACS.

The main limitations result from the retrospective nature of the work, the size of the group, the method of follow-up and are discussed.

The work is carried out correctly and the results are well presented.

The only minor comments concern text editing. The work requires careful reading and corrections, for example line 107 "The We retrospectively collected data" or several references that are incomplete (no. 14, 20, 27)

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The  paper covers important  issue of  cardiac care during  COVID-19 pandemic, especially secondary prevention of ACS. The  topic  of  the  study is of  high importance and  significance, thus the  pandemic  was a terrible  stress -test for  health-care systems, including cardiovascular serves.  

However,  from my point of view, the  paper requires extensive  revision for better understanding and  clearness.

1.       The aim of the study should be  clarified .  The same  about  the title.  The  main idea as I got it is a rate of achievement of target lipids  after  ACS in  COVID year in comparation   with 2015 and  2017. Moreover, two formulas for  LDL calculation were compared from this point of  view. It seems to be two different studies.

One possible  option is  to calculate  LDL levels  via  two formulas in 2015  and  2017 to present the  complete data.

Other-  to exclude  Martin-Hopkins and  present two formulas comparation as different paper.

 

2.       Abstract.  The  result section has to be clarified according  to corrections  of result section in the  main body of  the  paper (see above).   Conclusions represent  the mixture of  the  aims.  However the study reveals that beside lower number of available samples (35% vs 54-55% at  6- months and 43% vs 73-53% at 12-months), the proportion of achieved target lipids is stable. That is important  conclusion either.

3.        Introduction section represents the scope of problem. The  aim of the  study has to be clarified (comparation with 2015 and 2017?  Secondary aim for two formulas comparation&)

4.       Materials and  methods.

4.1   Patients.

1)      Direct dates for 2015 and  2017 patients population inclusion should be  clarified.

2)      6 and  12-months periods after discharge  for  data collection form databases should be mentioned

4.2   Determination of parameters. Sufficient

4.3   Calculation if LDL is  well written

4.4   Statistic is essential.

5.       Results.

1)      Patients inclusion diagram should be added that would mention follow up.

2)      It’s recommended to add  Table 1 with patients characteristics for 2021, 2015, 2017 that would include age, sex, DM,  STEMI/NSTEMI,  as percentage for follow-up at 6 and  12 months with p-value between the groups.  Moreover, current table 2 with  lipid-lowering  drugs prescription could be  integrated   into that table.

3)      Current  Table 1 is abundant. Actually, it shows the drugs work and   the patients are complaint with the treatment.  The  table could be presented as supplementary material.

4)      Tables 3 and 4  is a cornerstone of current publication.  Figure 1 partly duplicates Table 4.  The data requires decision how to present it according  to first comment.   If  you have ability to calculate LDL-MN  in 2015 and  2017 cohorts, I recommend to include parallel columns in  Figure 1 for  LDL-F and  LDL-MN for  2015, 2017 and  2021 with p-values between the years and between the methods in one  year.

 

6.       Discussion is good. Figure 2 is of high importance.

7.       Limitation section  should added. One  important limitation is unavailability of direct LDL-measurement, thus you can only make assumption that LDL-MD is  more precised.

8. Conclusion have to be clarified

Comments on the Quality of English Language

Editing is required

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report

Comments and Suggestions for Authors

Paper is  corrected. Could  be recommended for  the  Journal

Author Response

Thank you for your positive response.